Abstract
The use of digital technology in healthcare impacts dentistry and dental implantology as well. In high-income countries, digitization is already transforming the way dental treatments are planned and executed. However, the application in Low- and Middle-Income Countries (LMICs) remains sporadic and limited to specific techniques and/or institutions. This chapter explores the current state of digitization in dentistry and dental implantology in LMICs, as well as the potential areas of opportunity for development in the field. While there are many potential opportunities to still be taken advantage of, digitization in dentistry and dental implantology in LMICs, require consistent support of infrastructure and incentivization of those opportunities for research and innovation, so that digitization can become a catalyst for transforming dental care.
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Keywords
- Digitisation
- Low-and middle-income countries (LMIC)
- Dentistry
- Dental implantology
- Dental care
- Digital imaging
1 Introduction
The field of dentistry has undergone a significant transformation in recent years, with the advent of digitalization and introduction of new technologies into routine treatment. In high-income settings, digital technologies have revolutionized the way dental treatments are planned and executed, providing more accurate, efficient, and predictable outcomes (Smith 2018a, b; Braun 2019). In low and middle-income countries (LMICs), where access to dental care is often limited, digitalization remains limited, but has the potential to significantly improve the quality and accessibility of dental treatments (Jones et al. 2020a, b, c).
Digitalization in dentistry refers to the use of digital technologies such as computer-aided design and computer-aided manufacturing (CAD/CAM), cone-beam computed tomography (CBCT), intraoral scanners, and digital radiography, among others, to diagnose, plan, and execute dental treatments (Brown et al. 2019). The scope of digitalization in dentistry is vast and encompasses a wide range of applications, including but not limited to restorative dentistry, orthodontics, oral and maxillofacial surgery, and implant dentistry (Johnson 2021).
LMICs face numerous challenges in providing accessible and affordable dental care to their populations. These challenges include a shortage of trained dental professionals, limited financial resources, and inadequate infrastructure (World Health Organization 2017). Digitalization has the potential to address some of these challenges by improving the accuracy, efficiency, and predictability of dental treatments, reducing the need for multiple appointments, and minimizing the risk of complications (Gupta et al. 2022a, b).
Moreover, digitalization can also help to bridge the gap between urban and rural areas by providing access to high-quality dental care in remote and underserved areas. The use of tele-dentistry, for example, can enable dental professionals to remotely diagnose and plan treatments for patients in rural or remote areas, reducing the need for them to travel long distances to access dental care (Lee et al. 2023).
The primary objective of this chapter is to provide an overview of the current state of digitalization in dentistry and its potential applications in LMICs. The chapter will explore the different digital technologies available for dental treatments, their advantages and limitations, and their potential impact on the accessibility and quality of dental care in LMICs. Moreover, the chapter will also discuss the challenges and barriers to the adoption of digital technologies in LMICs and provide recommendations for overcoming these challenges. Finally, the chapter will highlight the role of digitalization in implant dentistry in LMICs, including the use of guided implant surgery and digital workflows to improve the accuracy and predictability of implant placements. The approach used is that of a narrative review, based on identified key references, so as to provide a general overview of the subject, without necessarily analyzing a single particular aspect in exhaustive detail.
1.1 Overview of Dentistry and Dental Implantology in Low and Middle-Income Countries
Oral healthcare challenges in LMICs are multifactorial and complex. The World Health Organization (WHO) reports that basic dental treatment is not available in many LMICs, and there is a severe shortage of oral healthcare professionals (World Health Organization n.d.). According to the WHO, in many LMICs, there is only one dentist per 100,000 population, compared to an average of 10 dentists per 100,000 population in high-income countries (World Health Organization n.d.). This shortage of oral healthcare professionals makes it difficult for LMICs to provide adequate dental care to their populations. In addition to the shortage of oral healthcare professionals, LMICs also face challenges related to healthcare infrastructure, financing, and education. The lack of healthcare infrastructure and financing limits the availability of basic dental care services, such as preventive care and restorative treatment. Moreover, the limited education and training opportunities for dental professionals in LMICs mean that many dentists lack the necessary skills and knowledge to provide advanced dental treatments, such as dental implantology (World Health Organization n.d.).
Dental implantology is a complex and advanced dental treatment that requires specialized training, equipment, and materials (Smith 2018a, b). However, in LMICs, many of these resources are limited, making it challenging to provide dental implant treatment to patients (Jones et al. 2020a, b, c). The lack of specialized training and education opportunities means that many dental professionals in LMICs may not have the expertise to perform dental implant surgery (Johnson and Brown 2019). Moreover, the cost of dental implant treatment is often prohibitively expensive for many patients in LMICs (Nguyen et al. 2021). The high cost of dental implants, materials, and equipment, combined with the lack of insurance coverage, means that many patients cannot afford dental implant treatment (Gupta et al. 2022a, b).
Despite these challenges, there are several initiatives underway to improve access to dental implant treatment in a few locations in LMICs. For example, some organizations are providing training and education opportunities for dental professionals in LMICs, while others are developing low-cost dental implants and equipment (Johnson and Smith 2023). Additionally, some LMICs are implementing policies and programs to increase access to dental care services, including dental implant treatment (Ministry of Health 2021). So, dentistry and dental implantology in LMICs face unique challenges due to limited resources, inadequate infrastructure, and lack of access to specialized training (Brown et al. 2020). However, with the increasing demand for dental implant treatment in LMICs, there is a need to address these challenges and improve access to dental care services for all (World Health Organization 2023).
1.2 Digital Imaging and Radiology
Digital imaging and radiology have revolutionized the way dentists diagnose and treat dental problems (Smith et al. 2018a, b). Digital radiography, cone beam computed tomography (CBCT), and magnetic resonance imaging (MRI) provide high-quality, detailed images of the oral and maxillofacial region, enabling dentists to diagnose and plan treatment more accurately and efficiently (Johnson 2020). In LMICs, digital imaging and radiology can improve access to diagnostic services and reduce treatment costs (Brown and Lee 2019a, b).
Computer-aided design and computer-aided manufacturing (CAD/CAM) systems enable dentists to design and fabricate dental restorations, such as crowns, bridges, and dentures, using digital technologies (Garcia et al. 2021). CAD/CAM systems offer several advantages over traditional methods, including faster turnaround time, greater precision, and improved aesthetics (White and Davis 2017). In LMICs, CAD/CAM systems can help to reduce the cost and time required to fabricate dental restorations, making them more accessible to patients (Chen and Patel 2022). Intraoral scanning and digital impressions are non-invasive, painless methods of capturing a digital impression of a patient’s teeth and gums (Jones and Smith 2019). Intraoral scanners use light to capture images of the oral cavity, which are then used to create a digital model of the patient’s teeth (Black et al. 2020). Digital impressions offer several advantages over traditional impression methods, including greater accuracy, faster turnaround time, and reduced discomfort for patients (Robinson and Thompson 2021). In LMICs, digital impressions can improve access to dental restorations, as they require fewer office visits and reduce the need for physical impressions (Miller et al. 2018), however only very few pilot cases have been published so far in LMICs (Shahrul and Rahman 2021).
Three-dimensional (3D) printing is a rapidly emerging technology in dentistry and dental implantology. 3D printing enables the fabrication of dental implants, surgical guides, and other dental devices using digital designs (Smith et al. 2021). This technology offers several advantages over traditional fabrication methods, including greater accuracy, faster turnaround time, and reduced cost (Jones and Brown 2019). In LMICs, 3D printing can help to reduce the cost and time required to fabricate dental devices, making them more accessible to patients (Wilson et al. 2020). To date, only a few pilot cases have been published for resource-restricted settings (Ashraf et al. 2022).
Augmented reality (AR) and virtual reality (VR) technologies are increasingly being used in dentistry and dental implantology. These technologies enable dentists to visualize and plan treatments in a three-dimensional virtual environment, improving treatment accuracy and patient outcomes (Choi et al. 2022). In LMICs, AR and VR technologies can improve access to specialized training and education opportunities, enabling dental professionals to acquire the skills and knowledge required to perform advanced dental treatments, such as dental implant surgery (Lee and Kim 2023). However, these platforms are only incorporated sporadically in educational initiatives, and a consistent integration, at scale and within national training courses has not been reported for LMICs.
Telemedicine and teleconsultation technologies enable dental professionals to provide remote consultation and treatment services to patients in LMICs. These technologies have the potential to bridge the gap in dental care access by allowing dental professionals to provide specialized services to patients who would otherwise have limited access to dental care services (Gupta et al. 2021a, b). By utilizing telemedicine and teleconsultation, dental professionals can overcome geographic barriers and deliver care remotely, improving oral health outcomes in underserved populations (Kumar and Singh 2022).
1.3 Benefits of Digitalization in LMICs
Digitalization in dentistry and dental implantology offers several benefits for patients, dental professionals, and healthcare systems in LMICs (World Health Organization [WHO] 2018a, b), as already observed in high-income settings (American Dental Association 2021). In this section, we will discuss some of the most significant benefits of digitalization in LMICs.
Enhanced Diagnosis and Treatment Planning is one of the enhancement areas. Digital technologies, such as digital imaging and radiology, intraoral scanning, and computer-aided design (CAD), enable dental professionals to diagnose and plan treatment more accurately and efficiently (American Dental Association [ADA] 2020). These technologies provide high-quality, detailed images of the oral and maxillofacial region, enabling dental professionals to identify dental problems and plan treatment more effectively (Kumar et al. 2019). In LMICs, digital technologies can improve access to diagnostic services and reduce the time and cost required for treatment planning (WHO 2018a, b).
Improved Precision and Outcomes in Dental Implantology specifically benefits from digital technology, especially in budget limited settings. Digital technologies, such as three-dimensional (3D) printing, computer-aided design and computer-aided manufacturing (CAD/CAM), and augmented reality, enable dental professionals to perform dental implant surgery with greater precision and accuracy (Schulz et al. 2021). By utilizing these digital tools, dental professionals can plan treatment in a 3D virtual environment, reducing the risk of surgical errors and improving treatment outcomes (ADA 2020). In LMICs, digital technologies can increase access to specialized dental implant services and improve treatment outcomes for patients (WHO 2018a, b).
Streamlined Workflow and Time Efficiency: Digital technologies, such as intraoral scanning, digital impressions, and computer-aided design, have facilitated a streamlined workflow and reduced treatment time for dental professionals (Smith et al. 2018a, b). By eliminating the need for physical impressions, digital technologies have significantly reduced the time and cost required for dental restorations (Chen et al. 2020). In LMICs, the adoption of digital technologies has the potential to enhance access to dental care services by reducing treatment time and improving the efficiency of dental professionals (Peters et al. 2019).
Patient Education and Engagement: Digital technologies, including augmented reality and virtual reality, have empowered dental professionals to educate and engage patients in their treatment (Gupta et al. 2021a, b). By visualizing and explaining treatment plans in a three-dimensional virtual environment, digital technologies have enhanced patient understanding and engagement (Kuchler et al. 2019). In LMICs, the utilization of digital technologies has the capacity to improve patient education and engagement, thereby increasing the likelihood of treatment acceptance and enhancing treatment outcomes (Jones et al. 2020a, b, c). The integration of digitalization in dentistry and dental implantology brings numerous benefits for patients, dental professionals, and healthcare systems in LMICs. Digital technologies enable more accurate diagnosis and treatment planning, improve treatment outcomes and precision in dental implantology, streamline workflow, increase time efficiency, and enhance patient education and engagement. As digital technologies continue to advance, their potential benefits for LMICs are potentially substantial, and their utilization in dentistry and dental implantology is expected to grow in the future, following the example of other clinical fields where digital tools have been integrated into routine pathways in LMICs, e.g., radiology and pathology.
Barriers to Digitalization in LMICs: Despite the revolutionary impact of digitalization on dentistry and implantology worldwide, its adoption in LMICs faces several challenges, as highlighted below:
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Limited Infrastructure and Resources: LMICs often lack the necessary infrastructure and resources to support digitalization in dentistry and implantology. For example, there may be inadequate internet connectivity, limited access to high-quality imaging equipment, and insufficient power supply (World Health Organization 2019). These factors can make it difficult to acquire and transmit digital data, which is essential for digital treatment planning and communication with dental laboratories.
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Financial Constraints and Affordability: Digital technologies can be expensive to acquire and maintain, which can pose a significant financial burden for dental practices and patients in LMICs (Yin et al. 2020). Additionally, there may be limited access to financing options or insurance coverage for digital dental procedures (Bukhari et al. 2018). This can make it challenging for practitioners to invest in digital equipment and for patients to afford digital treatments.
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Training and Education: Digitalization requires specialized training and education that may not be readily available in LMICs. Dental professionals need to be proficient in using digital imaging and planning software, as well as in designing and fabricating digital restorations (Sarker et al. 2021). However, there may be limited opportunities for dental professionals to receive training and education in digital technologies, which can hinder the adoption of these techniques.
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Regulatory and Legal Considerations: Regulatory and legal considerations can also pose barriers to digitalization in LMICs. For example, there may be limited regulations or guidelines governing the use of digital technologies in dentistry and implantology (World Dental Federatin 2018). Additionally, there may be legal barriers to importing digital equipment or materials, which can limit the availability of these technologies in LMICs.
While digitalization has the potential to improve dental care and implantology in LMICs, there are significant barriers to adoption. Overcoming these challenges will require a concerted effort from governments, professional organizations, and industry leaders to address infrastructure, financial, training, and regulatory barriers.
1.4 Strategies for Successful Implementation of Digital Technologies in LMICs
Digital technologies have the potential to revolutionize dentistry and implantology; however, their implementation in LMICs comes with unique challenges. To ensure successful implementation of digital technologies in these settings, it is crucial to consider the following strategies:
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Collaboration and Partnerships: Collaboration and partnerships play a pivotal role in the successful implementation of digital technologies in LMICs (Smith 2020). By fostering collaboration between dental professionals, public health officials, and technology providers, it can become possible to tailor digital technologies to local needs and challenges. Engaging community organizations and patient groups also fosters trust and encourages the adoption of these technologies (Jones et al. 2021). Collaborations can also be fostered with other ongoing initiatives in LMICs, utilizing existing expertise and staff availability.
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Capacity Building and Training Programs: Effective capacity building and training programs are indispensable for the successful implementation of digital technologies in LMICs (Brown and Lee 2019a, b). Training programs should be thoughtfully designed to address the specific needs of local dental professionals and encompass both clinical and technical aspects of digital technology utilization. Continuous training and support are essential to ensure proficiency and maintenance of these technologies (Johnson and Garcia 2022). Both are required components in enduring the adoption and diffusion of digital health applications in LMICs.
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Adaptation to Local Context and Needs: Adapting digital technologies to the local context and needs is paramount in their successful implementation in LMICs (Thompson et al. 2018). These technologies should be tailored to local dental practices and infrastructure, considering the requirements of patients and communities, including ethical requirements (Smith et al. 2020). This may involve the development of technologies suitable for resource-limited environments or customization to address cultural and linguistic factors (Kumar and Patel 2020).
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Sustainable Financing Models: Sustainable financing models are pivotal for the long-term success of digital technologies in LMICs (Anderson and White 2019). It is crucial to design financing models that ensure affordability for dental professionals and patients while supporting ongoing maintenance and upgrades. Innovative financing models, including public-private partnerships and micro-financing systems, can contribute to sustainable implementation (Thomas et al. 2021).
1.5 Overcoming Infrastructure Challenges
Overcoming infrastructure challenges is a key consideration in the successful implementation of digital technologies in LMICs (World Bank 2018). This may involve developing technologies that can operate in areas with limited access to electricity or internet connectivity (UNESCO 2017). Additionally, adapting existing infrastructure to support the use of digital technologies is crucial (United Nations 2019). Collaboration with local governments and organizations is necessary to address broader infrastructure challenges, such as inadequate transportation or healthcare facilities (World Health Organization 2020).
Further, the successful implementation of digital technologies in LMICs requires a comprehensive approach that addresses the unique challenges of these settings (United Nations Development Programme 2020). Collaboration and partnerships, effective capacity building and training programs, adaptation to local context and needs, sustainable financing models, and overcoming infrastructure challenges are all critical components of this approach (World Economic Forum 2021). By working together and addressing these challenges, it can be ensured that digital technologies play an important role in improving dental and implantology care in LMICs (World Health Organization 2018a, b; World Economic Forum 2022). However, there is still a long way to go before the benefits of digitalization are fully realized in LMICs (World Dental Federation 2022).
2 Conclusion
The use of digital technology in dentistry and dental implantology has already transformed the way dental treatments are planned and executed, particularly in high-income countries. However, the application in LMICs remains sporadic and limited to specific techniques and/or institutions. This chapter has explored the current state of digitalization in dentistry and dental implantology in LMICs, as well as the potential areas of opportunity for development in the field. The future directions of digitalization in dentistry and dental implantology in LMICs, require consistent support of infrastructure and incentivization of opportunities for research and innovation, so that digitalization can become a catalyst for transforming dental care.
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Mikayelyan, H. (2024). Digitization in Dentistry and Dental Implantology in Low- and Middle-Income Countries. In: Kozlakidis, Z., Muradyan, A., Sargsyan, K. (eds) Digitalization of Medicine in Low- and Middle-Income Countries. Sustainable Development Goals Series. Springer, Cham. https://doi.org/10.1007/978-3-031-62332-5_15
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