Should we be afraid of dental robots? / Faut-il avoir peur des robots-dentistes ?

As it seems likely that France, at the forefront in the use of surgical robotic platforms, will authorize the deployment of dental robots in the short term, the purpose of this article is to question what is at stake in this technological revolution, for dental professionals, regulators but also (and above all) for patients: what awareness-raising will the intervention of machines bring? How does robotics reshuffle the cards of the care relationship? What are the ethical and public health issues? After having defined dental robots as non-humanoid, automated surgical devices with exclusive restorative vocation, we will see how the field of dental robotics currently oscillates between hopes and illusions. We will describe the new responsibilities and ethical requirements related to the introduction of these AI-powered technical objects, as well as the necessary safeguards that have to be implemented in order to avoid any moral buffer and to protect patients from any robotization (literally or metaphorically in the sense of 'zombification'). Finally, we will show that ultimately the question of robot-dentists is the natural evolution of unreasonable application of industrial processes to the rationalization of health and ectopic, neo-liberal practices shifting healthcare into a commercial commodity. Patients can participate in reversing this trend, by recalling that the centrality of the human person is the cornerstone of health professions.

Comme il est vraisemblable que la France, à la pointe dans l'utilisation des plateformes robotiques chirugicales, autorise à court terme le déploiement de robots-dentistes sur son territoire, l'objectif de cet article est d'interroger ce qui se joue dans cette révolution technologique, pour les professionnels du dentaire, les régulateurs, mais aussi (et surtout) pour les patients : quelle(s) prise(s) de conscience l'intervention de la machine et les mutations qui lui sont associées peuvent-elles amener ? Comment la robotique rebat-elle les cartes de la relation de soin ? Pour quels enjeux éthiques et de santé publique ? Après avoir défini les robots-dentistes comme des dispositifs chirurgicaux automatisés à vocation réparatrice, pour l'instant non anthropomorphes, nous verrons comment le domaine de la robotique dentaire oscille entre espoirs et illusions. Nous décrirons les nouvelles responsabilités et exigences éthiques liées à l'introduction de ces objets techniques équipés d'intelligence artificielle, ainsi que les nécessaires garde-fous à implémenter pour éviter toute distanciation morale et pour protéger la patientèle de toute robotisation (au sens propre ou au sens métaphorique de « zombification ¼). Nous montrerons enfin que la question du robot-dentiste n'est finalement que l'évolution naturelle de l'application déraisonnée de procédés industriels à la rationalisation de la santé et de pratiques néolibérales ectopiques conduisant à sa marchandisation. Les patients peuvent participer à l'infléchissement de cette tendance, en rappelant que la centralité de la personne humaine constitue la pierre angulaire des métiers de la santé.

Evaluation of Pharyngeal Background Mucosa in Patients with Superficial Hypopharyngeal Carcinoma.

OBJECTIVES/HYPOTHESIS: Transoral surgery (TOS) has become increasingly popular for patients with superficial hypopharyngeal squamous cell carcinoma (SCC). However, the number of patients in whom metachronous multiple SCC of the head and neck (HNSCC) occurs has also increased. In this study, we investigated whether multiple lugol-voiding lesions (LVLs) in the pharyngeal background mucosa observed during TOS would be a biomarker of metachronous HNSCC. STUDY DESIGN: Retrospective study. METHODS: We examined 362 patients who underwent TOS for superficial hypopharyngeal carcinoma. Endoscopic images were reviewed in a blinded fashion by two endoscopists. LVLs in the pharyngeal mucosa were graded as follows: A, no lesions; B, 1 to 4 lesions; and C, ≥5 lesions per endoscopic view. RESULTS: Cumulative incidence curves of secondary HNSCC in the groups of grades A, B, and C revealed 3-year incidence rates of 14.4%, 18.8%, and 29.3%, respectively (P = .001 for A vs. C and P = .002 for B vs. C). Cumulative incidence curves of third HNSCC in the groups of grades A, B. and C revealed 5-year incidence rates of 3.9%, 9.8%, and 19.6%, respectively (P = .001 for A vs. C and P = .006 for B vs. C). Cumulative incidence curves of fourth HNSCC in the groups of grades A, B, and C revealed 7-year incidence rates of 0%, 2.3%, and 13.2%, respectively (P = .025 for A vs. C and P = .009 for B vs. C). CONCLUSIONS: Multiple LVLs in the pharyngeal mucosa increase the risk of development of metachronous multiple HNSCC. LEVEL OF EVIDENCE: 3 (nonrandomized, controlled cohort/follow-up study) Laryngoscope, 131:2036-2040, 2021.

The Importance of Dental Appliances for Oral Commissure Reconstruction in Trauma-Induced Microstomia: A Clinical Report.

Reconstruction of the oral commissure is necessary after trauma, pathological resection, or electrical, chemical, or thermal burns. Using dental appliances is strongly recommended to prevent microstomia in victims with oral commissure injury caused by burns. These appliances can be modified from dynamic to static for more patient comfort during the healing period and used in trauma patients to prevent rounding of the labial commissure. Preventing relapse of microstomia and forming acute angles at the corner of the mouth are 2 optimal goals when performing this surgery.

The Use of Patient-Specific Implants in Oral and Maxillofacial Surgery.

This article summarizes the current use of patient-specific implants in oral and maxillofacial surgery.

Extractions to reconstruction: The Development of Oral & Maxillofacial Surgery in Australian and New Zealand.

Oral and Maxillofacial Surgery developed initially from Dentistry as exodontia. It then expanded into the surgical management of jaw disorders. As the specialty evolved, it came into increasing conflict with related surgical disciplines. In the 1960s and 1970s these external criticisms were well-founded as training in oral surgery was individual, solely University-based and highly variable. In the 1980s the speciality developed a plan which involved hospital-based surgical training, a mandatory high level college surgical examination and detailed workforce and training studies. These were progressively implemented over the next twenty years with a dual degree (medicine and dentistry) and a final fellowship (FRACDS (OMS)). This resulted in accreditation by the Australian Medical Council and the Australian Dental Council and recognition as a Principal Surgical Speciality by the Commonwealth Department of Health. This development was monitored by published workforce studies over three decades that are important yardsticks to inform the credentialing of dental specialists.

Changing pattern and etiology of maxillofacial fractures during the civil uprising in Western Libya

Background: The purpose of the present study was to evaluate changing pattern in characteristics of maxillofacial fractures and concomitant injuries in Western Libya During revolution and to assess the association between mechanism of injury and fracture patterns. Material and Methods: A retrospective review of medical records and radiographs of 187 patients treated for maxillofacial fractures from January 2010 to December 2012 was performed, there were 326 fractures in 187 patients. Results: The male: female ratio was 6:1. Most fractures occurred in patients aged 11 to 40 years, and few injuries occurred in patients aged > 50 years. Most fractures occurred from motor vehicle accidents, and other most frequent causes included assault, gunshot, and fall injuries. Most maxillofacial fractures involved the mandible, zygomatic complex, or maxilla. Most mandibular fractures occurred at the parasymphysis, angle, or condyle. Associated injuries most frequently involved the head, chest, and extremities. Most patients were treated with open reduction (132 patients [71%]), and 26 patients (14%) were treated nonoperatively. There were 21 complications (11%). Conclusions: In summary, motor vehicle accidents were the most frequent cause of maxillofacial fracture in western Libya, possibly because of the lack of seat belt legislation. Interpersonal violence was a less frequent cause of maxillofacial fracture, possibly because of the religious restriction on alcohol consumption (AU)

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How useful is 3D printing in maxillofacial surgery?

INTRODUCTION: 3D printing seems to have more and more applications in maxillofacial surgery (MFS), particularly since the release on the market of general use 3D printers several years ago. The aim of our study was to answer 4 questions: 1. Who uses 3D printing in MFS and is it routine or not? 2. What are the main clinical indications for 3D printing in MFS and what are the kinds of objects that are used? 3. Are these objects printed by an official medical device (MD) manufacturer or made directly within the department or the lab? 4. What are the advantages and drawbacks? METHODOLOGY: Two bibliographic researches were conducted on January the 1st, 2017 in PubMed, without time limitation, using "maxillofacial surgery" AND "3D printing" for the first and for the second "maxillofacial surgery" AND "computer-aided design" AND "computer-aided manufacturing" as keywords. Articles in English or French dealing with human clinical use of 3D printing were selected. Publication date, nationality of the authors, number of patients treated, clinical indication(s), type of printed object(s), type of printing (lab/hospital-made or professional/industry) and advantages/drawbacks were recorded. RESULTS: Two hundred and ninety-seven articles from 35 countries met the criteria. The most represented country was the People's Republic of China (16% of the articles). A total of 2889 patients (10 per article on average) benefited from 3D printed objects. The most frequent clinical indications were dental implant surgery and mandibular reconstruction. The most frequently printed objects were surgical guides and anatomic models. Forty-five percent of the prints were professional. The main advantages were improvement in precision and reduction of surgical time. The main disadvantages were the cost of the objects and the manufacturing period when printed by the industry. DISCUSSION: The arrival on the market of low-cost printers has increased the use of 3D printing in MFS. Anatomic models are not considered to be MDs and do not have to follow any regulation. Nowadays, they are easily printed with low-cost printers. They allow for better preoperative planning and training for the procedures and for pre-shaping of plates. Occlusal splints and surgical guides are intended for the smooth transfer of planning to the operating room. They are considered to be MDs and even if they are easy to print, they have to follow the regulations applying to MDs. Patient specific implants (custom-made plates and skeletal reconstruction modules) are much more demanding objects and their manufacturing remains nowadays in the hands of the industry. The main limitation of in-hospital 3D printing is the restrictive regulations applying to MDs. The main limitations of professional 3D printing are the cost and the lead time. 3D printed objects are nowadays easily available in MFS. However, they will never replace a surgeon's skill and should only be considered as useful tools.

Update MRONJ and perspectives of its treatment.

Antiresorptive agents are widely used in catabolic bone diseases. Not only bisphosphonates but also new drugs like Denosumab may induce osteonecrosis of the jaw as a side effect. The present review describes the current effect mechanisms of commonly used antiresorptives, pathogenetic theories for the development of antiresorptive-related osteonecrosis of the jaw (ARONJ), and potential risk factors. Furthermore, diagnostic modalities and treatment options as well as new and innovative strategies are discussed. The major key factor to avoid the occurrence of ARONJ still remains the implementation of throughout preventive measures.

New Frontiers in Biomaterials.

Scientific and technological advances have combined to lead the way into a new era of the ever-developing science of biomaterials and tissue regeneration. This field has rapidly grown and new frontiers have quickly been established. Despite obtaining satisfactory results with current methods, improved techniques that lead to diminished patient discomfort, more favorable long-term prognosis, and decreased health care costs continue to be the goals of researchers, patients, and surgeons. Biomaterials have undergone a rapid evolution from materials that simply replaced tissues to factors that stimulate a biological response in the body.

Estado actual del láser en odontología conservadora: Indicaciones, ventajas y posibles riesgos. Revisión bibliográfica / Actually in conservative dentistry laser: Indications, advantages and possible risks. Literature review

En la actualidad, el término odontología mínimamente invasiva es un concepto muy utilizado pero, a veces, de forma errónea. Se define como una filosofía de prevención a la hora de realizar cualquier tratamiento en boca, evaluación de riesgos individualizados, detección precisa y precoz de las lesiones, así como los esfuerzos para remineralizar las lesiones no cavitadas, para su cuidado preventivo y mineralizar las lesiones ya existentes. Esta especie de «disciplina» o procedimiento, se puede desarrollar a partir de varias técnicas y/o instrumentos, como el ultrasonido, air brasion, micro CT o el láser y sus diferentes tipos y aplicaciones. Por ello creemos importante establecer unos principios, bases o protocolo sobre qué es el láser en nuestra profesión y dentro de ella en el campo de nuestra subespecialidad, la odontología Conservadora y que abanico de opciones nos podemos encontrar y como se puede orientar hacia unas indicaciones específicas con las ventajas o desventajas que esto nos pueda acarrear (AU)

Today the term minimally invasive dentistry is a concept widely used, but sometimes incorrectly. It is defined as a philosophy of prevention when making any treatment in the mouth, assessment of individual risks, accurate and early detection of lesions, as well as efforts to remineralize lesions cavitated for preventive care and mineralize injuries already existing. This kind of «discipline» or procedure can be developed from various techniques and/or instruments, such as ultrasound, air brasion, or laser micro CT and its different types and applications. Therefore we believe important to establish principles, bases or protocol on what the laser in our profession and within the field of our subspecialty, conservative dentistry and range of options can find us and how can be directed to specific indications with the advantages or disadvantages that this may bring us (AU)

Análisis de las causas de exodoncia en la población infantil atendida en una clínica universitaria / Causes of tooth extraction

Introducción: conocer las causas de exodoncia en la población infantil, tanto en la dentición temporal como en la permanente, es necesario para poder valorar el impacto de las medidas preventivas, así como para definir las actuaciones en materia de salud bucodental. Material y métodos: estudio de campo epidemiológico, observacional, descriptivo, transversal en la práctica clínica habitual, siendo la población de estudio los menores de 18 años que acuden a la clínica universitaria y a los que se les exodoncia uno o varios dientes. Resultados: se realizaron 97 exodoncias a 55 pacientes (4% de la población atendida), un 58,8% eran niñas. La media de edad fue de 8,69 años (desviación estándar [DE] 2,15). El tramo etario en el que se realizaron más exodoncias fue el de seis a diez años (52,6%). La alteración de la erupción dentaria (39,2%) fue la causa más frecuente de exodoncia, seguido por la caries (34%). En la población inmigrante la causa más frecuente fue la caries (69,56%). Conclusiones: es necesario implementar, desde las consultas de Pediatría y gabinetes de Odontología, medidas preventivas en la población de seis a diez años potenciando hábitos dietéticos y nutritivos que faciliten una correcta reabsorción de la dentición temporal, para disminuir el número de exodoncias y conseguir una correcta salud oral (AU)

Introduction: to know the causes of tooth extraction in child population, both deciduous and definitive dentition, is necessary to be able to appreciate the impact of the preventive measures, as well as determine the intervention in matters of oral health to get a healthy population. Materials and methodologies: epidemiologic, observational, descriptive and transversal study is designed in the usual practice of odontology. Its population consisted of people under the age of 18 who went to University clinic, and those who got one or more teeth extracted. Results: 97 removals were made to 55 patients (4% of treated population), 58.8% were female patients. The average age was 8.69 (EV 2.15). The most frequent age range to have teeth extracted was from 6 to 10 years old (52.6%). Dental growing disorder was the most frequent cause of tooth extraction (39.2%), followed by caries (34%). In inmigrant population the most frequent cause was the caries (69.76%). Conclusions: it is necessary to introduce, from pediatric consulting rooms in odontology, preventive measures in the population from 6 to 10 years old, reinforcing dietary and nutritional habits which facilitate a proper reabsorption of deciduous dentition, to decrease the number of extractions and to get a good oral health (AU)

Enfermedad seudotumoral de la articulación temporomandibular: condromatosis sinovial / Pseudotumor disease of the temporomandibular joint: synovial chondromatosis

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[Principles of evidence-based medicine in dentistry and Maxillo-facial surgery].

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

Bone Tissue Engineering Challenges in Oral & Maxillofacial Surgery.

Over the past decades, there has been a substantial amount of innovation and research into tissue engineering and regenerative approaches for the craniofacial region. This highly complex area presents many unique challenges for tissue engineers. Recent research indicates that various forms of implantable biodegradable scaffolds may play a beneficial role in the clinical treatment of craniofacial pathological conditions. Additionally, the direct delivery of bioactive molecules may further increase de novo bone formation. While these strategies offer an exciting glimpse into potential future treatments, there are several challenges that still must be overcome. In this chapter, we will highlight both current surgical approaches for craniofacial reconstruction and recent advances within the field of bone tissue engineering. The clinical challenges and limitations of these strategies will help contextualize and inform future craniofacial tissue engineering strategies.